Mormugao Municipal Council: Applicable Forms Annexure Form No. 8 Form VIII MORMUGAO MUNICIPAL COUNCIL DEATH REPORT Legal Information This part to be added to the Death Register To be filled by the informant Date of Birth : (Enter the exact 1. day, ..................................................................................... month and year the death took place (e.g. 1-1-2000) Name of the 2. deceased : .................................................................................................... (Full name as usually written) Sex of the deceased : ....................................................................................................... 3. (Enter "Male or female",do not use abbreviation) Age of the deceased (if the deceased was over 1 year of age, give ........................................ 4. age in completed years, If the deceased was below 1 year of age, give age in months and if below 1 month give in completed number of days, and if below one day, in hours.) Place of death : (Tick the appropriate entry 1,2 or 3 below and give ........................................ 5. the name of the Hospital/Institution or the address of the house where the death took place. If other place, give location) 1. Hospital/Institution Name : ............................................................................................ 2. House Address : ............................................................................................................ 3. Other place : ................................ ................................................................................ Name of the father/ 6. husband : ........................................................................................... http://www.mmcvasco.com/annexure/annexure9c.html (1 of 2) [3/16/2009 3:55:16 PM] Mormugao Municipal Council: Applicable Forms Informant's name : ........................................................................................................... 7. Address : ........................................................................................................................... (After completing all columns 1 to 17, informant will put date and signature here:) Date: Signature or left thumb mark of the informant Click here to fill in the Statistical Information in Death Report Back to 'Certificate of Birth/Death' http://www.mmcvasco.com/annexure/annexure9c.html (2 of 2) [3/16/2009 3:55:16 PM]
